Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Friday, August 03, 2007

Feeding the Beast

I want to be the first to go on record and say that a 90-minute door-to-balloon time for the treatment of an Acute Coronary Syndrome is not good enough.

After all, there are two important studies that appeared in Circulation this week (here and here) that have demonstrated that maybe half of the patients can achieve the 90-minute goal if we just devote enough resources! The Wall Street Journal even noted how cleaning staff can be diverted to help transport patients in smaller, outlying health care facilities:

When a Level 1 heart case is declared, everyone has a specific job to do. One rural hospital assigns its cleaning lady to help push the stretcher to the helicopter. "Level 1 is all you have to say," says David Larson, an emergency-room doctor at Ridgeview Medical Center who helped develop the protocol. "You're all on the same page right off the bat."

I still think we can do better. I think we should have, say, 30-minute door-to-balloon times! We could save many, many more lives if we just focus, people!

Here’s how it will work:

When Charlie gets chest pain at 3AM, we’re gonna set up a system whereby he’ll just lift his cell phone, punch and hold “5” on the keypad (it’s the central number, and dialing just one number will save 30 seconds!), and activate the Emergency Chest Pain System (ECPS).

The ECPS will be a well-coordinated team of specialized health care professionals devoted to saving lives 24/7/365. State-of-the-art telecommunications will permit live, continuous monitoring of transport operations from Emergency Rooms of each of the designated Centralized Chest Pain Centers (CCPC). Even Charlie’s cell phone will transmit his continuous EKG on a Specialized Medical Frequency (SMF) to the CCPC in real-time. The ECPS will have a Centralized Coordination Center (CCC) that will help determine which resources we should bring to bear to save Charlie’s life. The CCC will have at its disposal decision-support software that will have live feeds from GPS, weather, and ground transportation monitoring systems specially-developed to streamline patient flow from the street to the Emergency Room.

Should there be a tie-up of traffic on I-94, then the CCC will determine the location where Charlie’s cell phone originates from and re-route the response team from the ground to the air. A specially designed Sikorsky jet helicopter that we have designated for this purpose equipped with the latest medical technology and defibrillators. Never mind that you can't hear a blood pressure on the helo. It's time that matters! The Sikorsky will also permit twice the range as conventional medical helicopters because it is equipped with jet engine technology. Charlie can just walk out his door and the Sikorsky will come to him! (Time saved – 45 minutes!). Oh, and don’t worry if there might be inclement weather, our team of crack professionals will have specially-designed helo’s equipped with the latest infrared and night vision systems to tackle any weather!

Next, we’ll need to clear the airspace. Once the ECPS is activated, the government air-traffic control system will be notified by the CCC to clear the airspace to provide the most direct flight path between Charlie and the CCPC. Time saved (10 minutes).

Once Charlie arrives at the CCPC, specially-designed transport tubes will ascend from the CCPC to meet the Sikrorsky hovering overhead, and apply high, continuous suction to expedite Charlie’s transport into the Angiography Suite at the CCPC. Money will be saved here because people will no longer be needed to transport Charlie from the aircraft to the catheterization laboratory. (Time saved - 10 minutes)

There, our well-trained and ever-attentive gnomes doctors who will now be living at the facility around the clock (time saved - 30 minutes) to support the expedited care, will perform the necessary catheterization procedure to open Charlie’s artery.

What did you say? His EKG only showed T wave inversion? Well, we’ll cath him anyway, just to be sure!

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.